Parkinson's Disease

Question 1

What are the core features of Parkinson’s disease?

Answer 1

• Bradykinesia (can be seen when asking patient to preform a repetitive movement, will continue to get slower),
• Pill rolling tremor/resting tremor
• Lead pipe rigidity (jerky feeling when tone is tested)
• Postural instability

Question 2

What are the non-motor Parkinson’s symptoms?

Answer 2

• Dementia
• Depression and anxiety,
• Constipation,
• Postural hypotension
• Urinary urgency,
• Erectile dysfunction,
• Hallucinations and delusions
• rem behavioural disorder

Question 3

What are causes of Parkinsonism?

Answer 3

• Drug induced (antipsychotics or metoclopramide)
• Lewy body dementia,
• Multiple system atrophy,
• Progressive supranuclear palsy,
• Vascular parkinsonism

Question 4

What factors exclude a diagnosis of Parkinson’s disease?

Answer 4

• Cerebellar signs
• Vertical gaze palsy,
• Possible drug induced parkinsonism,
• Absence of L-dopa response,
• Cortical sensory loss,
• Normal scan

Question 5

What are some red flag symptoms that will indicate atypical Parkinson’s disease?

Answer 5

• Rapid gait impairment,
• No progression of motor symptoms >5y,
• Marked bulbar dysfunction within 5y,
• Inspiratory respiratory dysfunction,
• Recurrent falls,
• Absence of non-motor symptoms within 5y

Question 6

What are the aims of pharmacological treatment of Parkinson’s and some of the drug classes?

Answer 6

Aims - Restore dopamine levels and improve motor symptoms/QOL.
Drug classes: L.dopa, dopamine agonists, MAO-B inhibitors and COMT-inhibitors

Question 7

Name some examples of L-DOPA drugs and their side effects

Answer 7

• L-dopa with carbidopa/benserazide
• Side effects include nausea, vomiting, postural hypotension, confusion and hallucinations.

Question 8

Name some examples of dopamine agonists and their side effects

Answer 8

• Ropinirole or Apomorphine
• Side effects: Dopaminergic side effects, daytime somnolence or impulse control disorders

Question 9

Name some examples of MOA-B inhibitors

Answer 9

• Selegiline or Rasagiline
• Can be used as monotherapy or in adjunct with other drugs. Generally well tolerated

Question 10

Name an example of COMT inhibitors

Answer 10

• Entacapone
• Results in loner L-dopa half life so used in combination. Can cause diarrhoea

Question 11

What drugs can be used for anti-dyskinertic effect

Answer 11

Amantadine which can cause confusion

Question 12

What are some problems in advanced Parkinson’s

Answer 12

Motor - motor complications, on/off fluctuations and L-dopa-induced dyskinesia.
Axial - Gait difficulties, change in posture, poor balance/falls, speech and swallowing difficulties.
Cognitive- Dementia and hallucinations/psychosis

Question 13

What are treatment options for advanced parkinson’s?

Answer 13

• Apomorphine pen injections/subcutaneous pump.
• Intrajejunal duodopa infection,
• Deep brain stimulation - Electrical stimulation of the subthalamic nucleus. It is targeted, adjustable and non-destructive

Question 14

What are some parkinson’s emergencies?

Answer 14

• Severe dyskinesia,
• Acute psychosis, impulsivity, dopamine dysregulation and autonomic features,
• Falls,
• Device releated fails